Small injuries in the dentition and surrounding anatomy can, with any luck, cause minimal pain and may require a small restoration. Carious lesions, for example, could be treated with the removal of affected tissue and the application of an aesthetic composite restoration, allowing the patient to leave the dental chair after a straightforward appointment, and carry on with their day.
In many cases of tissue resorption, however, this is not the case. Patients could be at severe risk of adverse oral health outcomes. If resorbed tissue is not accounted for and treated, restorations could fail and patients may require further time in the dental chair.
It’s important to understand how resorption occurs, as well as recognise effective treatment approaches.
Tooth resorption
Let’s start with a positive – not all tooth resorption is bad. In the case of deciduous teeth, physiologic tooth resorption aids in the process of the exfoliation of the primary dentition, making room for the permanent teeth to settle.[i] However, for people who have developed their permanent teeth, tooth resorption is obviously undesirable.
Damage can be caused to structural dentine and/or cementum resulting in the loss of tissue. There are a variety of aetiologies and pathogeneses that can be linked to each case.[ii] However, there are three factors that are consistent between each instance of tooth resorption: the breakdown of natural barriers in the tissues, a continuous stimulating factor, and a viable blood supply for clastic cells.ii The clastic cells are responsible for mineralised tissue resorption, but can be dangerous when uncontrolled.[iii]
Internal root resorption is rare, but observed throughout the literature. It is associated with pulpal inflammation, which drives blood flow and clastic cells to the pulp chamber, causing damage from the inside out.[iv] Conservative treatment options include root canal treatment, which removes the blood supply to the clastic cells, but surgical intervention may be necessary.iv If treatment is late or ineffective, the tooth may require extraction and replacement.
External root resorption occurs when the cementum layer or similar tooth tissue is damaged or removed.[v] It tends to occur most often in people aged 21 to 30 years old, and is more common in female patients.v It may begin as a result of trauma, failed periodontal surgery or pressure from adjacent unerupted teeth, or even as a result of uncontrolled orthodontic tooth movement.v Treatment depends on the extent of resorption, from pain relief and the stabilisation of any mobile teeth, to removal of resorptive tissue, and potentially the need for regeneration and tissue augmentation at the treatment site.v
Bone resorption
Resorbed bone is important to control in the maxillofacial structure for positive oral health outcomes. It is a natural pattern for bone tissue to be ‘activated’ and resorbed, before being remodelled and formed into a new structure, but the presence of disease can modify such a delicate homeostatic balance, resulting in a continuous destructive process.[vi] When patients do not adequately displace subgingival plaque, inflammatory periodontal diseases can develop, instigating such outcomes.
Another cause is an initial loss of a tooth, which then prompts bone resorption at the site. This is linked to the local bone being supported by blood in the periodontal ligament – without a tooth, resorption is expected.[vii]
Loss of bone can be significantly detrimental. It can change the appearance of the face in extreme cases, as well as reduce support for the surviving dentition. Many patients will experience bone resorption concurrently with other issues, as seen with periodontal diseases and tooth loss.
Augmentation of hard tissue
Placing a restoration in resorbed tissue can be complex, including dental implants. The literature reports that 50% of all implants and almost 75% of implants in the anterior maxilla require bone augmentation to compensate for resorption as a result of tooth loss.vii
The choice in augmentation technique will differ dependent on the patient’s anatomy and the needs for the implant to maintain stability for long-term success. However, the literature signals positive rates of survival and success for implants in augmented bone[viii] – dental professionals must choose a predictable and effective approach to maximise this result.
The PG Diploma in Advanced Techniques in Implant Dentistry from One to One Implant Education helps clinicians develop their soft and hard tissue augmentation skills, with hands-on opportunities to practise a wide range of techniques. The course is completely evidence-based, and ensures clinicians can treat complex dental implant cases with confidence, from augmentation and placement to long-term management.
Tooth and bone resorption will each rely on different techniques for recovery, but success can be found when clinicians have confidence in a range of treatment approaches.
To reserve your place or to find out more, please visit
https://121implanteducation.co.uk or call 020 7486 0000.
Author: Dr Fazeela Khan-Osborne
[i] Patel, S., & Saberi, N. (2018). The ins and outs of root resorption. British dental journal, 224(9), 691-699.
[ii] Abbott, P. V., & Lin, S. (2022). Tooth resorption—Part 2: A clinical classification. Dental Traumatology, 38(4), 267-285.
[iii] Arana-Chavez, V. E., & Bradaschia-Correa, V. (2009). Clastic cells: mineralized tissue resorption in health and disease. The international journal of biochemistry & cell biology, 41(3), 446-450.
[iv] Nilsson, E., Bonte, E., Bayet, F., & Lasfargues, J. J. (2013). Management of internal root resorption on permanent teeth. International journal of dentistry, 2013(1), 929486.
[v] Ahangari, Z., Nasser, M., Mahdian, M., Fedorowicz, Z., & Marchesan, M. A. (2015). Interventions for the management of external root resorption. Cochrane database of systematic reviews, (11).
[vi] Hienz, S. A., Paliwal, S., & Ivanovski, S. (2015). Mechanisms of bone resorption in periodontitis. Journal of immunology research, 2015(1), 615486.
[vii] Nørgaard Petersen, F., Jensen, S. S., & Dahl, M. (2022). Implant treatment after traumatic tooth loss: A systematic review. Dental Traumatology, 38(2), 105-116.
[viii] Keestra, J. A. J., Barry, O., Jong, L. D., & Wahl, G. (2016). Long-term effects of vertical bone augmentation: a systematic review. Journal of Applied Oral Science, 24, 3-17.
